Looking after your sexual health

Non-specic urethritis
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Non-specic urethritis
Urethritis is infammation (pain, redness and/or
swelling) of the urethra (tube where urine comes
out). Sometimes it is called non-specifc urethritis
(often known as NSU) or non-gonococcal
urethritis (NGU). In this booklet we use the term
non-specifc urethritis. This means infammation of
the urethra when the cause is not yet known and
the sexual infection gonorrhoea (which can cause
infammation) has been ruled out. It is possible for
men and women to have non-specifc urethritis,
but it is more diffcult to diagnose in women.
This booklet only discusses non-specifc
urethritis in men. It gives you information about
non-specifc urethritis, what you can do if you are
worried you might have it and advice on how to
protect yourself.
What causes non-specifc urethritis?
There are many different causes. Some, but not all,
are passed on through having sex. If you have non-
specifc urethritis there may be more than one
cause, and in some men a cause is never identifed.
If you have signs of infammation in your
urethra it is common to be told you have non-
specifc urethritis straightaway, before the cause
is known. You will probably be tested for sexually
transmitted or possibly urinary tract infections to
try to fnd out what the cause of the infammation
is. You may have to wait for these results.
Causes of non-specifc urethritis include:
Sexually transmitted infections
O Chlamydia is a common cause of non-specifc
urethritis.
O Genital herpes and trichomonas vaginalis are
less common causes.

Contents
What causes non-specifc urethritis? .......................................... 3
How is non-specifc urethritis passed on sexually? ............ 5
What are the signs and symptoms? ............................................ 5
How will I know if I have non-specifc urethritis? ................ 6
How soon after sex can I have a test? ....................................... 6
What does the test involve? ............................................................ 7
How accurate are the tests?............................................................ 8
Where can I get a test? ...................................................................... 8
Will I have to pay for tests and treatment? ............................ 8
What is the treatment for non-specifc urethritis? ............. 9
When will the signs and symptoms go away? ....................... 9
Do I need to have a test to check that the non-specifc
urethritis has gone? ............................................................................ 10
What happens if non-specifc urethritis isnt treated? ... 10
Can non-specifc urethritis go away without
treatment? ............................................................................................... 11
How soon can I have sex again? ................................................ 11
Will I know how long Ive had the infection? ...................... 11
Should I tell my partner? ................................................................ 12
How will I know if non-specifc urethritis has affected my
fertility? .................................................................................................... 12
How can I protect myself from non-specifc urethritis
and other sexually transmitted infections? ........................... 13
Using a service ..................................................................................... 14
Where can I get more information and advice? ............... 14
A fnal word ........................................................................................... 16
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Other organisms
O Tiny organisms called mycoplasma genitalium
and ureaplasma urealyticum can live in the
body without causing symptoms but sometimes
they multiply quickly, leading to infammation
of the urethra. Being ill or stressed could cause
this to happen. It is thought these organisms
may be transmitted sexually.
O Some bacteria that live in the rectum and the
mouth and throat can be passed on during sex
and cause infammation.
O Bacteria that cause infection in the urinary tract
(kidneys, bladder and urethra) or the prostate
gland can lead to infammation of the urethra.
O A vaginal infection in your partner, such as
thrush or bacterial vaginosis, may trigger non-
specifc urethritis in you.
Damage to the urethra
This can be caused by friction during vigorous
sex or masturbation, or inserting objects into the
urethra. Frequently inspecting or squeezing your
urethra can also irritate it and cause infammation
some men do this if they have recently had an
infection or they are worried they might have one.
Antibacterial liquids
Applying liquids such as tea tree oil, antiseptic
or disinfectant or using medicated or highly
perfumed shower gels can cause infammation.
Sensitivity or irritation
Rarely, infammation can occur if your skin is very
sensitive to chemicals, such as those in latex (in
condoms, for example), spermicide or soap.
How is non-specifc urethritis
passed on sexually?
During unprotected vaginal, anal or oral sex,
organisms which cause infammation can pass into
the urethra. Non-specifc urethritis can occur in
any man who is sexually active. You dont need to
have lots of sexual partners.
Not all cases of non-specifc urethritis are
caused by having sex.
You cannot get non-specifc urethritis from
kissing, hugging, sharing baths or towels or from
toilet seats.
What are the signs and symptoms?
Not all men who have infammation will show any
signs or symptoms, or they may be so mild they
are not noticed.
If signs and symptoms do occur they usually
show up within 24 weeks of contact with an
infection, but they can sometimes appear within
a day or two (depending on the cause of the
infammation). In mild cases, symptoms may not
show up for several months. If you do get signs
and symptoms you might notice:
O A white or cloudy discharge from the tip of the
penis, usually more noticeable frst thing in the
morning. Sometimes this discharge is seen only
when massaged out of the penis.
O Diffculty, pain or a burning sensation when
passing urine.
O The feeling that you need to pass urine
frequently.
O Itching or irritation at the end of the urethra.
Depending on the cause of the infammation
there may also be other symptoms that are
specifc to particular infections.
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How will I know if I have non-
specifc urethritis?
You can only be certain if you have a test. Because
the infammation can be caused by sexually
transmitted infections you may wish to be tested
for infection if:
O you have, or think you might have, symptoms
O you have recently had unprotected sex with a
new partner
O you or your partner have had unprotected sex
with other partners
O a sexual partner tells you they have a sexually
transmitted infection.
How soon after sex can I have a
test?
It is important that you dont delay getting a test
if you think you may have an infection. You can
have a test even if you havent got symptoms. It
is possible to be tested for signs of infammation
within a few days of having sex, but it may be
necessary to wait up to two weeks before
you can do a test to check for infections such
as chlamydia. Routine tests for mycoplasma
genitalium and ureaplasma urealyticum are not
currently widely available in the UK but may be
offered at some clinics, particularly to men with
persistent non-specifc urethritis.
What does the test involve?
As well as testing for signs of infammation it
is recommended that you also have a test for
chlamydia and gonorrhoea at the same time.
The type of sample that is collected will depend
on whether you have any signs and symptoms
and what infections you are being tested for.
The tests may involve a doctor or nurse:
O using a swab to collect a sample of cells from
the entrance of the urethra
O asking you to give a urine sample
O examining your penis.
A swab looks a bit like a cotton bud, but is smaller
and rounded. It sometimes has a small plastic loop
on the end rather than a cotton tip. It is wiped
over the parts of the body that could be affected
and easily picks up samples of discharge and cells.
It only takes a few seconds and is not usually
painful, though it may be uncomfortable for a
moment.
In some services they can look at the sample
under the microscope straightaway and tell you
if there are signs of infammation. It may also be
possible to give you the results of tests for other
sexually transmitted infections straightaway. You
may, however, have to wait 12 weeks to fnd out
if the non-specifc urethritis is being caused by a
sexually transmitted infection or is due to other
infection in the urinary tract.
Routine blood tests do not detect non-specifc
urethritis. If you are not sure whether you have
been tested, just ask.
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How accurate are the tests?
The accuracy of looking for signs of infammation
under the microscope depends on the skill of the
person doing the test and how long ago you last
passed urine. Most men are advised not to urinate
for at least two hours beforehand so that the test
is as accurate as possible. You may be tested for
various causes of non-specifc urethritis, and these
tests have different levels of accuracy.
If you have signs and symptoms but the test
doesnt confrm non-specifc urethritis, you may be
asked not to pass urine overnight and come back
to be tested again.
Where can I get a test?
There are a number of services that you can go
to. Choose the service you feel most comfortable
with. A test can be done at:
O a genitourinary medicine (GUM) or sexual
health clinic
O general practices
O some contraception and young peoples clinics.
For information on how to fnd a service see page
14.
Will I have to pay for tests and
treatment?
All tests are free through NHS services. Treatment
is also free unless you go to your general practice,
when you may have to pay a prescription charge
for the treatment.
What is the treatment for non-
specifc urethritis?
Non-specifc urethritis is treated with antibiotics.
O If the test shows that infammation is present,
or if there is a high chance that you have an
infection, you will be given treatment even if the
cause is not yet known.
O There are several different antibiotics that can
be used, either as a single dose or a longer
course (up to two weeks).
O Some men may get non-specifc urethritis
more than once, and for a few men it may
become persistent (keep coming back). If this
happens, you may be given a second course, or
a combination, of antibiotics.
O You may also need other treatment if
complications have occurred (see What
happens if non-specifc urethritis isnt treated?
on page 10) or the cause of the infammation
becomes known.
O There is no evidence that complementary
therapies can cure non-specifc urethritis.
When will the signs and symptoms
go away?
Most men notice an improvement in the
symptoms quite quickly, with the discharge and pain
on passing urine usually improving within a week.
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Do I need to have a test to check
that the non-specifc urethritis has
gone?
Some services may ask you to go back and see
them for a check-up two weeks later, and some
may do a follow-up on the phone. This is to:
O check that the signs and symptoms have gone
O check that you were able to take the treatment
correctly
O check that you have not been exposed to an
infection again
O give you the results of any other tests that
were done, and give you advice on how to get
further treatment if necessary
O answer any questions you have and give you
any advice you need on protecting yourself
from infection.
If you still have signs or symptoms you may need
to be tested again and have more treatment.
What happens if non-specifc
urethritis isnt treated?
If non-specifc urethritis is detected and treated
early there are no complications. If left untreated,
some causes of non-specifc urethritis can have
long-term consequences, although these are
uncommon. They can include:
O Painful infection in the testicles.
O Possible reduced fertility.
O Infammation of the joints. This is known as
reactive arthritis. Sometimes reactive arthritis
is accompanied by infammation of the eyes as
well as the urethra if this happens it is known
as Reiters Syndrome.
Non-specifc urethritis caused by chlamydia can
lead to pelvic infammatory disease (PID) in your
female sexual partner(s). This can lead to long-
term pelvic pain, blocked fallopian tubes, infertility
and ectopic pregnancy (when the pregnancy
develops outside the uterus).
It is not known whether some other causes of
non-specifc urethritis (for example, mycoplasma
genitalium) can lead to PID, but it is thought that it
may be possible.
Can non-specifc urethritis go away
without treatment?
This will depend very much on the cause. If you
delay seeking treatment you risk an infection
causing long-term damage and you may pass the
infection on to someone else.
How soon can I have sex again?
It is strongly advised that you do not have any
sexual intercourse, including vaginal, anal or oral
sex until you and your partner have both fnished
the treatment and any follow-up treatment. This
is to help prevent you being reinfected or passing
the infection on to someone else and to allow the
urethra to heal.
Will I know how long Ive had the
infection?
The tests cannot tell you how long the infection
has been there. If the non-specifc urethritis has
been caused by a sexual infection and you have
had more than one sexual partner, it can be
diffcult to know which partner it came from.
If you feel upset or angry about having an
infection and fnd it diffcult to talk to your partner
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or friends, dont be afraid to discuss how you feel
with the staff at the clinic or general practice.
Should I tell my partner?
Because non-specifc urethritis is often caused by
a sexually transmitted infection it is very important
that your current sexual partner(s) and any other
recent partners are also tested and treated. The
staff at the clinic or general practice can discuss
with you which of your sexual partners may need
to be tested.
You may be given a contact slip to send or
give to your partner(s) or, with your permission,
the clinic can do this for you. The slip explains
that they may have been exposed to a sexually
transmitted infection and suggests that they go
for a check-up. It may or may not say what the
infection is. It will not have your name on it, so
your confdentiality is protected. This is called
partner notifcation. You are strongly advised to
tell your partner(s), but it isnt compulsory.
In some men who are not responding to
treatment, non-specifc urethritis may only clear
up after their partner has been treated too.
How will I know if non-specifc
urethritis has affected my fertility?
Sexual infection is just one of many factors that
can affect your fertility.
Having non-specifc urethritis will not affect the
fertility of most men. If you have had non-specifc
urethritis you will not normally be offered any
routine tests to see if you are fertile unless your
partner is having diffculty getting pregnant. If you
do not want your partner to get pregnant, it is still
important to use contraception. You should not
assume you are infertile. If you are concerned, talk
to your doctor or practice nurse.
How can I protect myself from non-
specifc urethritis and other sexually
transmitted infections?
It is possible to get non-specifc urethritis and
other sexually transmitted infections by having
sex with someone who has an infection but has
no symptoms. The following measures will help
protect you from non-specifc urethritis and most
other sexually transmitted infections including HIV,
gonorrhoea and chlamydia. If you have a sexually
transmitted infection they will also help prevent
you from passing it on to your partner.
O Use condoms (male or female) every time you
have vaginal or anal sex.
O If you have oral sex, use a condom to cover the
penis, or a latex or polyurethane (soft plastic)
square to cover the female genitals or male or
female anus.
O Avoid sharing sex toys. If you do share them,
wash them or cover them with a new condom
before anyone else uses them.
O If you are not sure how to use condoms
correctly visit www.fpa.org.uk for more
information.
Another way to help protect yourself against
non-specifc urethritis is to avoid putting objects,
lotions or creams into your urethra.
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Using a service
O Wherever you go, you shouldnt be judged
because of your sexual behaviour.
O All advice, information and tests are free. All
services are confdential.
O All tests are optional and should only be done
with your permission.
O Ask as many questions as you need to and
make sure you get answers you understand.
O The staff will offer you as much support as you
need, particularly if you need help on how to
tell your partner.
Where can I get more information
and advice?
The Sexual Health Information Line provides
confdential advice and information on all aspects
of sexual health. The number is 0800 567 123
and the service is available from Monday to Friday
from 9am - 8pm and at weekends from 11am -
4pm.
For additional information on sexual health visit
www.fpa.org.uk
Information for young people can be found at
www.brook.org.uk
Clinics
To locate your closest clinic you can:
O Use Find a Clinic at www.fpa.org.uk/clinics
O Download FPAs Find a Clinic app for iPhone or
Android.
You can fnd details of general practices and
pharmacies in England at www.nhs.uk and in
Wales at www.nhsdirect.wales.nhs.uk. In Scotland
you can fnd details of general practices at
www.nhs.24.com and in Northern Ireland at
www.hscni.net
A fnal word
This booklet can only give you general information.
The information is based on evidence-based guidance
produced by The British Association of Sexual Health and
HIV (BASHH).
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www.fpa.org.uk
The Sexual Health Line is provided by the Department of Health. This
booklet is produced by the sexual health charity FPA, registered charity
number 250187. Limited liability company registered in England, number
887632. Supported by the Department of Health. FPA does not run the
Sexual Health Line.
FPA printed January 2014 ISBN 978-1-908249-66-1
The information in this booklet was accurate at the
time of going to print. Booklets are reviewed regularly.
Next edition available in 2015.
If you would like the information on the evidence used
to produce this booklet or would like to provide us with
feedback about this booklet email feedback@fpa.org.uk